Joint support and subchondral support system

ABSTRACT

A joint support and subchondral support system and method of use of same for providing structural and dampening support to damaged subchondral bone adjacent to a body joint are disclosed. The joint support and subchondral support system and method of use of same are applicable to many parts of the joint as any area with cartilage disease has an adjoining subchondral component.

CROSS-REFERENCE TO RELATED APPLICATIONS

This is a continuation application of U.S. patent application Ser. No.12/328,493, filed Dec. 4, 2008, which is incorporated herein byreference in its entirety.

FIELD OF THE INVENTION

The present invention relates to the field of medical devices, and morespecifically to a joint support and subchondral support system andmethod of use of same for providing structural and dampening support inthe treatment of damaged subchondral bone in the disease process ofjoints such as osteoarthritis, chondral defects, and osteonecrosis, inhumans or animals.

BACKGROUND OF THE INVENTION

Isolated articular cartilage defects and generalized cartilage disease,athroses and arthritis, respectively, in human and animal joints havecertain surgical treatment options, which attempt to mimic or recreatenormal anatomy and joint mechanics and/or relieve symptoms ofdiscomfort, instability, or pain. Isolated disease often progresses togeneralized disease, or arthritis—the process is a continuum.Generalized arthritis may also develop without known prior isolateddisease. Arthritis may be present as a uni-, bi-, or tri-compartmentaldisease.

Uni-compartmental arthritis is typically less amenable to surgicaloptions used for smaller isolated articular defects. With advancedcartilage degeneration and joint space narrowing, there is typicallyincreased axial deformity and misalignment. Surgical options includeosteotomy or uni-compartmental replacement. Options for bi- ortri-compartmental arthritis are combined procedures or total kneereplacement.

Cartilage disease has been previously addressed by various means ofreplacing or substituting the damaged cartilage. Microfracture orabrasionplasty is a form of irritating exposed bone to createreplacement fibrocartilage, but the resultant material is inferior tonative cartilage. Osteochondral transplant replaces plugs of diseasedcartilage and accompanying subchondral bone with grafts from either thepatient or human cadaver. Small discrete lesions work well, but largerlesions, bipolar disease, and diffuse disease are not well addressed.Chondrocyte implantation harvests the patient's cartilage cells, growsthem, and re-implants them on the bony bed, and covers them with aperiosteal patch. Each of the aforementioned techniques work best forsmall contained lesions, unipolar defects (i.e., one side of joint), andprimarily femoral condyle lesions. Less optimal results occur withpatellofemoral joint disease, and tibial sided disease.

A further method of treating cartilage disease is to realign the jointwith an osteotomy. This relieves an overloaded compartment, transferringstress to a less diseased compartment. Success of this method involvesavoiding non-union and other complications, and requires prolongednon-weight bearing activity and eight to twelve months to realizeclinical benefits. Only patients with mostly uni-compartmental diseaseare candidates. Osteotomy also complicates latter joint replacement.

Arthroscopy is used to treat other causes of pain from arthritis,namely, loose bodies, loose or frayed cartilage, meniscus tears, andsynovitis. These are temporizing measures.

The end stage of cartilage disease is to perform total jointreconstruction. This type of procedure presents a prolonged recoverytime and surgical risks. Because total joint prostheses are fabricatedof metal and plastic, revision surgery for worn-out components isfraught with much higher complications than primary surgery, and isinevitable if the patient lives much beyond ten years.

Not much is known about the cause and progression of arthritis. Withcurrent diagnostic techniques such as MRI and bone scintigraphy, morehas been elucidated about the disease process. In particular, thesubchondral bone plays an important role in the initiation andprogression of arthritis. Arthritis is a disease of not just thecartilage, but the underlying subchondral bone as well. Most of theclinical research to date is focused on cartilageregeneration/replacement and not on the underlying bone health.

Traditionally, cartilage has been viewed to be avascular, with diffusionof nutrients occurring from within the joint. Studies have confirmed,however, that subchondral bone is a source of vascular and nutritionalsupport for cartilage. With age, vascular and structural support fromthe subchondral bone diminishes, allowing arthritic disease to progress.Namely, the inability of the bone to adequately repair itself asincreasing damage occurs starts a cycle of further destruction,interfering with cartilage vascular supply and structural support.

As cartilage wear occurs, the primary functions of cartilage—to providea low-friction bearing surface and to transmit stresses to theunderlying bone—are diminished. Bone is most healthy when resistingcompressive stresses. The shear stresses from the joint are partiallyconverted to compression and tension via the architecture of thecartilage baseplate, the layer between the cartilage and underlying boneis undulating. Further, by virtue of the ultra low friction surface ofcartilage on cartilage (20× lower friction than ice on ice), shearstresses are mostly converted to longitudinal. The subchondral bone isthe predominant shock absorber of joint stress. Via its arch-likelattice-work of trabecular bone, stresses are transmitted to the outercortices and ultimately dissipated. Cartilage itself does very littleshock absorption secondary to its shear thickness and mechanicalproperties.

Bone is the ultimate shock absorber, with fracture being the endpoint offorce attenuation. Trabecular microfractures have been shown to occur inlocations of bone stress in impulsively loaded joints. Every joint has aphysiologic envelope of function—when this envelope of function isexceeded, the rate of damage exceeds the rate of repair. As cartilagedisease progresses, subchondral bone is less able to dissipate thestress it encounters, i.e., shear-type stresses. The attempts ofsubchondral bone to heal and remodel are seen as arthritisprogresses—osteophyte formation, subchondral sclerosis, cyst formation,and subchondral MRI-enhanced changes, and increased signal on bonescintigraphy. Joint deformity from these changes further increases jointreaction force. Cartilage homeostasis is compromised—structural,vascular, neural, and nutritional.

Clinical success of current cartilage surgery is limited as it generallyonly works for small, uni-polar (one-sided joint) lesions of the femoralcondyle. No current treatment exists for bone edema or osteonecrosis ofthe knee.

It would be desirable to have a minimally invasive joint support andsubchondral support system and method of use of same that specificallyaddresses the subchondral bone in arthritic disease process andprogression, and relieves the pain that results from diseasedsubchondral bone and the spectrum of symptoms that result fromarthritis, including pain, stiffness, swelling, and discomfort. It wouldbe further desirable to have a joint support and subchondral supportsystem and method of use of same that provides as follows: (1) atreatment specifically for bone edema and bone bruises and osteonecrosisthat has previously not existed; (2) structural scaffolding to assist inthe reparative processes of diseased bone next to joints; (3) shockabsorbing enhancement to subchondral bone; (4) compressive, tensile, andespecially shear stress attenuation enhancement to subchondral bone; (5)a means to prevent further joint deformity from subchondral boneremodeling such as osteophyte formation; (6) assistance in the healingof or prevention of further destruction of overlying cartilage bymaintaining and allowing vascularity and nutritional support fromsubchondral bone; (7) assistance in the healing of or prevention offurther destruction of overlying cartilage by providing an adequatestructural base; (8) a minimally invasive alternative to total jointreconstruction that also does not preclude or further complicate jointreconstruction; (9) a treatment for subchondral bone disease in its rolein arthritis and delay or halt further progression; (10) an implant forarthritis that is minimally subject to loosening or wear, as it isintegral to the trabecular framework it supports; (11) an alternativefor tibial sided, patellofemoral, and bipolar disease (tibial-femoral)that is relatively easy to perform, as an adjunct to arthroscopy, and asan outpatient procedure with minimal downtime for the patient; (12) atreatment for arthritis that allows higher lever of activity than thatallowed after joint resurfacing or replacement; (13) a cost effectivealternative to joint replacement with less issues about the need forrevision and surgical morbidity, especially in countries with lessmedical resources; and (14) a treatment option in veterinary medicine,specifically in equine arthroses and arthritides, among other desirablefeatures, as described herein.

SUMMARY OF THE INVENTION

The present invention provides a joint support and subchondral supportsystem or device and method of use of same for the treatment of damagedsubchondral bone in arthritic disease process and progression. Thepresent invention is described herein for the human knee joint, but thedevice and method of use of same may apply to other joints and species.In a first aspect, the present invention includes a joint support andsubchondral support system for providing structural and dampeningsupport to damaged subchondral bone adjacent to a body joint. The jointsupport and subchondral support system includes at least onenon-telescoping primary bearing strut element of variable geometry andthickness having a longitudinal body and a vertically disposed inneredge and outer edge, suitable for insertion within the subchondral bone.The longitudinal body has a porosity to allow vascularity, bridgingbone, and other biological elements to pass through. The verticallydisposed inner edge and outer edge have pronged scalloping at a bottomend to penetrate the subchondral bone during insertion and to maintainthe at least one non-telescoping primary bearing strut element in placewithin the subchondral bone. The vertically disposed outer edge has aplurality of hollow grooves formed vertically therethrough, wherein theplurality of hollow grooves are configured to receive a multi-prongedlongitudinal insertion holder during insertion of the at least onenon-telescoping primary bearing strut element within the subchondralbone, and the vertically disposed outer edge is contoured to fit thesubchondral bone at a treatment site.

In certain embodiments, the multi-pronged longitudinal insertion holderforms a plurality of vascular channels in the subchondral bone duringinsertion of the at least one non-telescoping primary bearing strutelement within the subchondral bone whereby blood or marrow may accessthe vertically disposed outer edge through the plurality of hollowgrooves or vascular channels.

In certain embodiments, single or multiple geometric shapes of the atleast one non-telescoping primary bearing strut element may beconfigured to be joined to each other in various patterns such that thesingle or multiple geometric shapes penetrate the subchondral bone atthe treatment site.

In certain embodiments, the single or multiple geometric shapesconfigured to be joined together include at least three connectingstruts to form a multiple concentric circle in which each circle of theat least one non-telescoping primary bearing strut element is connectedto an adjacent circle by the connecting struts.

In certain embodiments, the at least one non-telescoping primary bearingstrut element has a diameter of from about 1 mm to about 5 cm and aheight/depth of from about 1 mm to about 3 cm.

In certain embodiments, the at least one non-telescoping primary bearingstrut element includes a primary bearing flare for resisting subsidencewithin the subchondral bone at the treatment site.

In certain embodiments, the at least one non-telescoping primary bearingstrut element includes a secondary flare extending below the strutelement for further resisting subsidence within the subchondral bone atthe treatment site.

In certain embodiments, the secondary flare is at least one of avertical, double-tapered wing strut, and obliquely extending arm.

In certain embodiments, the porosity of the longitudinal body may becomprised of micropores, scaffold-like pores, or a fibrous matrixmaterial.

In certain embodiments, the at least one non-telescoping primary bearingstrut element includes a concentric taper from the vertically disposedouter edge to the inner edge.

In certain embodiments, the at least one non-telescoping primary bearingstrut element may have a geometry in the form of a multiple concentriccircle, joined circles, hexagon, octagon, or other non-euclidean shapes.

In certain embodiments, a biocompatible bearing surface cover may beattached to a periphery of the vertically disposed outer edge to containmarrow contents entering through vascular channels or exogenoussubstances injected through the cover.

In certain embodiments, at least one active or passive dampening elementis attached to the at least one non-telescoping primary bearing strutelement for dissipating and dampening shock within the subchondral bone.

In a further aspect, there is provided herein a method of providingstructural and dampening support to damaged subchondral bone adjacent toa body joint. The method includes providing at least one non-telescopingprimary bearing strut element of variable geometry and thickness havinga longitudinal body and a vertically disposed inner edge and outer edge,suitable for insertion within the subchondral bone. The verticallydisposed outer edge is contoured to fit the subchondral bone at thetreatment site. The method further includes providing a multi-prongedlongitudinal insertion holder and configuring the vertically disposedouter edge to have a plurality of hollow grooves formed verticallytherethrough for receiving the multi-pronged longitudinal insertionholder. The subchondral bone is penetrated during insertion of the atleast one non-telescoping primary bearing strut element within thesubchondral bone at the treatment site. The at least one non-telescopingprimary bearing strut element is maintained in place within thesubchondral bone. Vascularity, bridging bone, and other biologicalelements, are allowed to pass through a porosity of the longitudinalbody when positioned at the treatment site.

In certain embodiments, the step of configuring the vertically disposedouter edge to have a plurality of hollow grooves formed verticallytherethrough includes slidably disposing the multi-pronged longitudinalinsertion holder downward through the plurality of hollow grooves at thevertically disposed outer edge during insertion of the at least onenon-telescoping primary bearing strut element within the subchondralbone at the treatment site.

In certain embodiments, the step of penetrating the subchondral boneincludes forming a plurality of vascular channels in the subchondralbone during insertion of the at least one non-telescoping primarybearing strut element within the subchondral bone whereby blood ormarrow may access the vertically disposed outer edge through theplurality of hollow grooves or vascular channels.

In certain embodiments, the step of penetrating the subchondral boneincludes configuring the vertically disposed inner edge and outer edgeto have pronged scalloping at a bottom end suitable for penetrating thesubchondral bone during insertion of the at least one non-telescopingprimary bearing strut element within the subchondral bone at thetreatment site.

In certain embodiments, the step of penetrating the subchondral boneincludes tamping the at least one non-telescoping primary bearing strutelement and multi-pronged longitudinal insertion holder into thesubchondral bone and removing the multi-pronged longitudinal insertionholder from the treatment site.

In certain embodiments, the step of maintaining the at least onenon-telescoping primary bearing strut element in place within thesubchondral bone includes configuring the vertically disposed inner edgeand outer edge to have pronged scalloping at a bottom end thereof.

In certain embodiments, the step of maintaining the at least onenon-telescoping primary bearing strut element in place within thesubchondral bone includes configuring the at least one non-telescopingprimary bearing strut element to have a primary bearing flare forresisting subsidence within the subchondral bone at the treatment site.

In certain embodiments, the step of maintaining the at least onenon-telescoping primary bearing strut element in place within thesubchondral bone includes configuring the at least one non-telescopingprimary bearing strut element to have a secondary flare extending belowthe strut element for further resisting subsidence within thesubchondral bone at the treatment site.

In certain embodiments, the step of configuring the at least onenon-telescoping primary bearing strut element to have a secondary flareextending below the strut element includes forming the secondary flareas a vertical, double-tapered wing strut or an obliquely extending arm.

In certain embodiments, the step of allowing vascularity, bridging bone,and other biological elements to pass through a porosity of thelongitudinal body includes configuring the porosity of the longitudinalbody to be comprised of micropores, scaffold-like pores, or a fibrousmatrix material.

These and other features and advantages of this invention will becomefurther apparent from the detailed description and accompanying figuresthat follow. In the figures and description, numerals indicate thevarious features of the disclosure, like numerals referring to likefeatures throughout both the drawings and the description.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a perspective view of an embodiment of a joint support andsubchondral support system according to the present invention.

FIGS. 2A-2C illustrate the various degrees of porosity of the contoured,porous plate of the embodiment of FIG. 1.

FIGS. 3A-3B are perspective views of the dampening element of the jointsupport and subchondral support system according to the presentinvention.

FIGS. 4A-4E illustrate the placement of the device of FIG. 1 insubchondral bone of the tibial plateau.

FIG. 5A illustrates the placement of the device of FIG. 1 in subchondralbone of the femoral condyle and the tibial plateau as a monobloc insert.

FIG. 5B is a top plan view of the placement of the device of FIG. 1 insubchondral bone of the tibial plateau as both a modular insert and amonobloc insert.

FIG. 5C is a front perspective view of the placement of the device ofFIG. 1 in subchondral bone of the femoral trochlea.

FIG. 5D is a front perspective view of the placement of the device ofFIG. 1 in subchondral bone of the patella.

FIG. 6 is a perspective view of another embodiment of the joint supportand subchondral support system according to the present invention.

FIGS. 7A-7D illustrate the placement of the device of FIG. 6 insubchondral bone of a knee joint.

FIG. 8 illustrates the placement of the elongated plate separately fromthe plurality of strut elements within the subchondral bone of the kneejoint as a modular insert.

FIG. 9 is an enlarged perspective view of the elongated plate releasablyattached to the plurality of strut elements of FIG. 6.

FIGS. 10A-10C illustrate the various degrees of porosity of theplurality of strut elements of the embodiment of FIG. 6.

FIGS. 11A-11H illustrate a top view of several variable orientations orgeometries of the plurality of strut elements of the embodiment of FIG.6.

FIG. 12A illustrates an enlarged perspective view of the plurality ofsuperior struts of the embodiment of FIG. 6.

FIGS. 12B-12D illustrate various configurations of the flared bearingsurface of the embodiment of FIG. 6.

FIG. 12E is a perspective view of the secondary bearing element of theembodiment of FIG. 6.

FIG. 13A is a perspective view of the dampening element as a longcylinder housed in the periphery of the device of FIG. 6.

FIG. 13B is a perspective view of the dampening element as individualspheres embedded in the periphery of the device of FIG. 6.

FIG. 14A is a perspective view of a further embodiment of the jointsupport and subchondral support system according to the presentinvention.

FIG. 14B illustrates the various configurations of the primary bearingflare of the device of FIG. 14A.

FIG. 15 illustrates the placement of the device of FIG. 14A insubchondral bone of a knee joint in a parallel orientation.

FIGS. 16A-16C illustrate the various degrees of porosity of the deviceof FIG. 14A.

FIGS. 17A-17G illustrate an enlarged perspective view of each of thedifferent cross-sectional shapes of the device of FIG. 14A.

FIG. 18 illustrates the placement of the device of FIG. 14A insubchondral bone of a knee joint in a radial versus parallelorientation.

FIG. 19 is an enlarged perspective view of the porous, bearing surfaceof the embodiment of FIG. 14A with associated secondary flares.

FIG. 20A is a cut-away view of another embodiment of the joint supportand subchondral support system according to the present invention.

FIG. 20B is a perspective view of the embodiment of FIG. 20A illustratedas a complete circle.

FIGS. 21A-21C illustrate the various degrees of porosity of the deviceof FIG. 20.

FIGS. 22A-22B illustrate the outer edge of the device of FIG. 20 havingconcave and convex curvatures.

FIG. 22C illustrates the concentric taper of the primary bearing strutelement of the embodiment of FIG. 20.

FIG. 23 illustrates the placement of the device of FIG. 20 insubchondral bone of a knee joint by monobloc via antegrade insertion.

FIGS. 24A-24C illustrate the varying levels of the depth of penetrationof the device of FIG. 20.

FIG. 25A is an enlarged perspective view of an insertion holder used inconjunction with the embodiment of FIG. 20 during insertion of thedevice within the subchondral bone.

FIG. 25B illustrates the placement of the insertion holder prongs withineach of the grooves of the embodiment of FIG. 20 during insertion of thedevice within the subchondral bone.

FIG. 26 illustrates a perspective view of the bearing surface cover inaccordance with the embodiment of FIG. 20.

FIGS. 27A-27F illustrate the various geometric shapes that can be formedby the primary bearing strut elements of the embodiment of FIG. 20.

FIG. 28 illustrates the placement of the device of FIG. 18 insubchondral bone of a knee joint with multiple devices joined to eachother to form various patterns.

FIG. 29A is a cut-away view of the embodiment of FIG. 20 with a primarybearing flare.

FIG. 29B is a perspective view of the embodiment of FIG. 20 with asecondary flare.

FIG. 30 is a perspective view of a further embodiment of the jointsupport and subchondral system according to the present invention.

FIG. 31 illustrates the placement of the device of FIG. 30 insubchondral bone of a knee joint.

FIG. 32 is a perspective view of the placement of the joint support andsubchondral support system of each of the embodiments in subchondralbone of a knee joint.

DETAILED DESCRIPTION OF THE INVENTION

The joint support and subchondral support system or device 10 of thepresent invention is generally illustrated in FIG. 1. It is contemplatedby the present invention that the joint support and subchondral supportsystem is not a substitute for partial or total joint replacement, butmay delay the need for joint replacement in active individuals withmoderate osteoarthritis and/or arthroses. By sustaining subchondral bonehomeostases, further joint deformity and disease progression may bedelayed and/or avoided. The joint support and subchondral support systemin accordance with the present invention enhances and reinforces thecartilage-bone complex in the presence of diseased cartilage or acartilage defect. It treats the bony side of the equation by mechanicalabsorption of shear and compressive stresses that threatencartilage-bone homeostasis.

A number of advantages of the joint support and subchondral supportsystem in accordance with the present invention are evident as follows:(1) the basic structure and mechanics of the system are applicable tomany parts of the joint, as any area with cartilage disease has anadjoining subchondral component; (2) minimal modifications inmanufacturing are necessary to apply this system to multiple areas,namely, the contour of the porous, plate closest to the joint; (3) thedevice may be inserted with minimal soft tissue dissection and minimalto no violation of the joint capsule if done in retrograde or side-slotinsertion methods; (4) antegrade devices also may be inserted with aminimal arthrotomy; for diffuse lesions with long anterior-posteriordimensions, two devices may be placed anterior and posterior to eachother through the same small arthrotomy; (5) the system is inherentlystable, as it occupies little space within the bone and is a jointscaffolding, not a replacement; and (6) the materials that comprise thesystem are dampening, thereby enhancing the trabecular bone's ability towithstand shock and shear stress.

The joint support and subchondral support system 10 includes acontoured, porous plate 12 having a variable shaped inner surface 14,outer surface 16, and peripheral surface 18 of variable thicknessextending between the inner surface 14 and the outer surface 16,suitable for insertion within the subchondral bone 20. The contoured,porous plate 12 inner surface 14, outer surface 16, and peripheralsurface 18 may be kidney-shaped, oval-shaped, or otherwise so shaped tofit within the subchondral bone 20 at the desired anatomic site. Theinner surface 14, outer surface 16, and peripheral surface 18 each havea respective concave portion 14A, 16A, 18A, and a respective convexportion 14B, 16B, 18B. The inner surface 14 of the contoured, porousplate 12 is closest to the joint 22 and the first part of the system 10that encounters stress. The inner surface 14 is configured to fit flushwith the respective geometries of the tibial and femoral sides of thejoint 22, and may be convex, concave, or complex to minor the particularanatomic location. The outer surface 16 will mirror the geometry of theinner surface 14. The geometry of the inner surface 14, outer surface16, and peripheral surface 18, may vary depending on the exact anatomiclocation being treated (i.e., proximal tibia versus femoral trochlea)and the specific geometry of the lesion being treated.

The contours 32 of the porous plate 12 may be configured to match thechondral/subchondral curvature and anatomy of the specific joint 22location. Alternatively, the contours 32 may not be configured to matchthe chondral/subchondral 20 curvature and anatomy of the specific joint22 location such that the contours 32 are neutral or assume a reverse orvaried polarity.

The contoured, porous plate 12 has a porosity 24 to allow vascularityand other biologic elements from the host to pass through the contoured,porous plate 12. The porosity 24 of the contoured, porous plate 12 iswithin a range of from about 50 microns to about 20 mm. As shown inFIGS. 2A-2C, the porosity 24 of the contoured, porous plate 12 may becomprised of micropores 26, scaffold-like pores 28, or fibrous matrixmaterial 30.

Referring further to FIG. 1, the contoured, porous plate 12 includes aplurality of surface dimpling 34, which increases the surface area forstress absorption and converts as much shear stress to compressive ortensile stress, as the cartilage baseplate of the joint 22 has similarfeatures. The surface dimpling 34 has a radius of from about 50 micronsto about 3 mm. The contoured, porous plate 12 may further include aplurality of undersurface pimples 36, which increase the surface areabelow the contoured, porous plate 12 to spread the load. Theundersurface pimples 36 have a radius of from about 50 microns to about3 mm.

The dimensions of the system or device 10 generally depend on the sizeof the lesion being treated. Typically, two or more devices 10 will bedeployed per location for diffuse disease and one device for smallerlesions. The vertical dimension ranges from about 1 mm to about 100 mmand the horizontal dimension ranges from about 1 mm to about 100 mm. Thecontoured, porous plate 12 has a cross-sectional area of from about 1mm² to about 100 cm². The peripheral surface 18 of the contoured, porousplate 12 has a variable thickness of from about 0.1 mm to about 5 cm. Atleast one active or passive dampening element 38 is attached to thecontoured, porous plate 12. A dampening element, such as a piezoelectricdevice, converts active mechanical energy to heat or electric, therebydissipating and dampening the shock. A passive dampening element 38 maybe made of silicone or other shock-absorbing material. Either active orpassive dampening element 38 may be incorporated into plate asillustrated in FIGS. 3A-3B. FIG. 3A illustrates the dampening element 38as a long cylinder housed in the periphery of the device 10. FIG. 3Billustrates the dampening element 38 as individual spheres embedded inthe periphery of device 10. The dampening element 38 may also beinherent within the material properties of the device, and not aseparate component, i.e., silicone-impregnated porous metal matrix.

Referring to FIG. 4, at least one to multiple guide pin holes or slots40 are located within device 10 to aid insertion within the subchondralbone 20. The guide pin(s) 42 are inserted into the anatomic siteinitially (FIG. 4A) with device 10 inserted over the guide pin(s) 42(FIG. 4B). A bone cutter/dilator 44 is inserted over the guide pin(s) 42to create an entry opening and slot 45 for device 10 (FIG. 4C). The bonecutter or dilator 44 is smaller in dimension than device 10, therebyallowing a press-fit fixation. The device 10 is inserted over the guidepin(s) 42 via the holes or slots 40 (FIG. 4D). The excess guide pin(s)42 may break away or be removed after device 10 is inserted within thesubchondral bone 20. One guide pin 42 may be used initially as device 10is allowed small amounts of swiveling to more exactly fit the contoursof the subchondral baseplate 20. Placement of the guide pin 42 into thesubchondral defect 20 may be accomplished by either fluoroscopicguidance, CT guidance, computer navigation guidance, or direct guidance.In one embodiment, the guide pin 42 may be configured to break away fromthe contoured, porous plate 12 upon insertion of the device 10 withinthe subchondral bone 20.

The operation of the device 10 for the femur involves placing a guidepin 42 into the center of the subchondral defect 20 from within thejoint 22. This is followed by a bone cutter or dilator 44 to prepare thebone. The device 10 is then inserted over the guide pin 42 andpositioned flush with the subchondral bone 20 with a tamp. The insertionof the device 10 is peripheral or tangential to the joint surface (FIG.4E).

FIG. 5A illustrates the placement of the joint support and subchondralsupport system or device 10 in subchondral bone 20 of the femoralcondyle and the tibial plateau as a monobloc 48 insert. FIG. 5B is a topplan view of the placement of the device 10 in subchondral bone 20 ofthe tibial plateau as both a modular 46 and a monobloc 48 insert. Asshown in FIG. 5B, the contoured, porous plate 12 may be inserted in atleast two different locations of the subchondral bone 20 as a modular 46or monobloc 48 insert. FIG. 5C is a front perspective view of theplacement of the device 10 in subchondral bone 20 of the femoraltrochlea. FIG. 5D is a front perspective view of the placement of thedevice 10 in subchondral bone 20 of the patella.

The joint support and subchondral support system 10 of the presentinvention may be fabricated from virtually any biocompatible material,including, but not limited to, metals, metal alloys, carbon fibers, foammetals, ceramics, ceramic composites, elastomer composites,elastomer-carbon fiber composites, chambered or fluid-filled materials,metal matrices, injectable gels, injectable composites with fluid andsold matrices, bone or bone-composite or allografts, crystal orhydroxyapatite materials, plastics (i.e., PEEK), polymers, bioabsorbablecomposites (i.e., TCP/PLLA), or composites/combinations of the abovematerials. The preferred materials for the system 10 have inherentelastic or shock absorbing properties.

In another embodiment as shown in FIG. 6, the joint support andsubchondral support system or device 50 includes an elongated plate 52having a plurality of tapered strut elements 54 of variable geometry andthickness oriented in a vertical configuration for insertion into thesubchondral bone 20. The strut elements 54 include a plurality ofsuperior struts 56 formed on an upper portion 58 of the plate 52 and aplurality of inferior struts 60 formed on a lower portion 62 of theplate 52. The plurality of inferior struts 60 may be configured to beout of plane with the plurality of superior struts 56. There may besingle to multiple superior or inferior struts depending on the size ofpathologic lesion being treated.

FIG. 7A illustrates the placement of the joint support and subchondralsupport system 50 in subchondral bone 20 of the femoral condyle andtibial plateau and patella in accordance with the present invention.

It is contemplated by the present invention that the elongated plate 52may be inserted separately from the plurality of strut elements 54within the subchondral bone 20 as a modular insert 64 shown in FIG. 8.

The elongated plate 52 serves as a secondary bearing element anddissipates stresses centripetally and absorbs stress inherently. Theelongated plate 52 thickness and material properties may vary to enablestress transmission outward. The elongated plate 52 prevents subsidenceof the structural support system 50. The dimension of the elongatedplate 52 is dependant on the size of lesion being treated. The verticaldimension ranges from about 1 mm to about 100 mm and the horizontaldimension ranges from about 1 mm to about 100 mm. The elongated plate 52has a cross-sectional area of from about 1 mm² to about 100 cm².

In one embodiment of FIG. 9, the elongated plate 52 is shown releasablyattached to the plurality of strut elements 54 with smoothly roundedjoint elements 66 at each intersection of the strut elements 54 and theelongated plate 52. The plurality of superior 56 and inferior 60 strutshave a width of from about 0.1 mm to about 10 mm and a height of fromabout 0.5 mm to about 35 mm.

The plurality of superior struts 56 serves to accept the load from theadjoining joint 22. The level of penetration of the superior struts 56within the subchondral bone 20 includes as follows: the superior struts56 may stop short or come up to the cartilage base plate, may penetratethe cartilage base plate and reside in the lower cartilage layer, or maycome flush to the native bearing cartilage surface. The plurality ofinferior struts 60 reinforces the structural integrity of the elongatedplate 52 and enables centripetal transmission/dissipation of forces tounderlying and surrounding structures (i.e., bone or soft tissue).

As shown in FIGS. 10A-10C, the plurality of strut elements 54 may befabricated to have a porosity comprised of micropores 68, scaffold-likepores 70, or fibrous matrix material 72. The porosity of the pluralityof strut elements is within a range of from about 50 microns to about 20mm.

The plurality of strut elements 54 may have a variable orientation orgeometry such as sinusoidal 74(FIG. 11A), parallel 76 (FIG. 11B), radial78 (FIG. 11C), circular 80 (FIG. 11D), curved (FIG. 11E),geometric—rectangular 82, trapezoidal 84, hexagonal 86, octagonal 88(FIG. 11F), cross-hatching or cross-elements 90 (FIG. 11G), or singlecolumns 91 (FIG. 11H).

FIG. 12A illustrates an enlarged perspective view of the plurality ofsuperior struts 56 of the joint support and subchondral support system50 of FIG. 6. The plurality of superior struts 56 have a primary bearingelement 92 configured to be contoured such that the primary bearingelement 92 is generally the same as the corresponding subchondral bone20 being treated. The primary bearing element 92 has an ultra-lowcoefficient of friction surface that is polished or fabricated of abiocompatible material. The primary bearing element 92 includes a flaredbearing surface 94 that is substantially wider than each of theplurality of superior struts 56. The flared bearing surface 94 may beconfigured to assume a variety of shapes such as circular (FIG. 12B),flat (FIG. 12C), mushroom-like (FIG. 12D), and the like. The flaredbearing surface 94 has a width of from about 1.1 to about 4× a width ofeach of the plurality of superior struts 56. The plurality of superiorstruts 56 may include at least one secondary bearing element 96 (FIG.12E) that connects the plurality of superior struts 56 to each other.The secondary bearing element 96 has a width of from about 0.5 to about5× the width of the superior strut 56.

A guide pin hole or slot 98 is positioned within the elongated plate 52oriented longitudinally for insertion and placement of the plate 52 andplurality of strut elements 54 over at least one corresponding guide pin102 within the subchondral bone 20 (FIGS. 7B-7D). At least one tomultiple guide pin holes or slots 98 are located within device 50 to aidinsertion within the subchondral bone 20. The guide pin(s) 102 isinserted into the anatomic site initially (FIG. 7C). A bonecutter/dilator 100 is inserted over the guide pin(s) 102 to create anentry opening and slot 98 for device 50 (FIG. 7D). The bonecutter/dilator 100 is smaller in dimension than device 50, therebyallowing a press-fit fixation. The device 50 is inserted over the guidepin(s) 102 via the guide pin holes or slots 98 (FIG. 7D). The excessguide pin(s) 102 may break away or be removed after device 50 isinserted within the subchondral bone 20. Placement of the guide pin 102into the subchondral defect 20 may be accomplished by eitherfluoroscopic guidance, CT guidance, computer navigation guidance, ordirect guidance. In one embodiment, the guide pin 102 may be configuredto break away from the elongated plate 52 upon insertion of the device50 within the subchondral bone 20.

Referring further to FIG. 7, the operation of the device 50 for thefemur involves placing a guide pin 102 into the center of thesubchondral defect 20 from within the joint 22. This is followed by abone cutter/dilator 100 to prepare the bone. The device 50 is theninserted over the guide pin 102 and positioned flush with thesubchondral bone 20 with a tamp. The insertion of the device 50 isperipheral or tangential to the joint surface (FIG. 7).

At least one active or passive dampening element 104 is attached to theelongated plate 52 and plurality of strut elements 54 (FIG. 13). Anactive dampening element, such as a piezoelectric device, convertsactive mechanical energy to heat or electric, thereby dissipating anddampening the shock. FIG. 13A illustrates the dampening element 104 as along cylinder housed in the periphery of the device 50. FIG. 13Billustrates the dampening element 104 as individual spheres embedded inthe periphery of the device 50. A passive dampening element may be madeof silicone or other shock-absorbing material. Either active or passivedampening element 104 may be incorporated into plate 52 as illustratedin FIGS. 13A-13B. The dampening element may also be inherent within thematerial properties of the device 50, and not a separate component,i.e., silicone-impregnated porous metal matrix.

The joint support and subchondral support system 50 of the presentinvention may be fabricated from virtually any biocompatible material,including, but not limited to, metals, metal alloys, carbon fibers, foammetals, ceramics, ceramic composites, elastomer composites,elastomer-carbon fiber composites, chambered or fluid-filled materials,metal matrices, injectable gels, injectable composites with fluid andsold matrices, bone or bone-composite or allografts, crystal orhydroxyapatite materials, plastics (i.e., PEEK), polymers, bioabsorbablecomposites (i.e., TCP/PLLA), or combinations/composites of the abovematerials. The preferred materials for the system 50 have inherentelastic or shock absorbing properties.

In a further embodiment as shown in FIG. 14A, the joint support andsubchondral support system 106 includes a plurality of separate verticalstruts 108 of variable geometry and thickness having a first end 110 anda second end 112, suitable for modular insertion 114 within thesubchondral bone 20. At least one of the plurality of vertical strutsfirst end 110 and second end 112 is tapered to assist in progressivelydissipating stress. The plurality of vertical struts 108 further includea porous, bearing surface 116 contoured to fit the subchondral bone 20being treated. The porous, bearing surface 116 is configured to includea primary bearing flare 118 of various configurations (FIG. 14B). Theprimary bearing flare 118 prevents subsidence of the joint support andsubchondral support system 106.

FIG. 15 illustrates the joint support and subchondral support system 106in subchondral bone 20 of the femoral condyle and tibial plateau inaccordance with the present invention.

As shown in FIGS. 16A-16C, the device 106 may have a porosity comprisedof micropores 118, scaffold-like pores 120, or fibrous matrix material122. The porosity of the device 106 is within a range of from about 50microns to about 20 mm.

FIGS. 17A-17G illustrate an enlarged perspective view of the differentcross-sectional shapes of the strut device 108, such as a triangular(both polarities) (FIG. 17A), smooth thermometer-like (FIG. 17B),trapezoid (FIG. 17C), flared diamond-shaped (FIG. 17D), oval (FIG. 17E),complex (tapered with flared-diamond) (FIG. 17F), and rectangular (FIG.17G).

The plurality of vertical struts 108 can be inserted in either aparallel orientation 140 (FIGS. 15 and 18) or a radial orientation 142(FIG. 18) within the subchondral bone 20. Radial orientation may enablecentripetal load dissipation within the subchondral bone. The top-downgeometry of the struts may be curved 108A, straight 108B, or sinusoidal108C as shown in FIG. 18.

The embodiment of FIG. 19 illustrates an enlarged perspective view ofthe porous, bearing surface 116 having a secondary bearing flare 144extending below the bearing surface 116. The secondary bearing flare 144distributes the load horizontally, along the vertical length of theplurality of vertical struts 108. The secondary bearing flare 144 can bein the form of either a horizontal wing strut 146 or dimple 148. Thedimple 148 can be asymmetric in shape in which it is wider towards thejoint.

It is contemplated by the present invention that the plurality ofvertical struts 108 are implanted within the subchondral bone 20 viaside slot insertion as shown in FIG. 15.

Referring further to FIG. 19, at least one active or passive dampeningelement 150 is attached to the plurality of vertical struts 108. Thedampening element may be within the main strut body 150A or housedwithin the secondary bearing flare 150B. A dampening element, such as apiezoelectric device, converts active mechanical energy to heat orelectric, thereby dissipating and dampening the shock. The dampeningelement 150 may also be inherent in the material properties of thedevice 106, i.e., silicone-injected porous metal matrix.

The joint support and subchondral support system 106 of the presentinvention may be fabricated from virtually any biocompatible material,including, but not limited to, metals, metal alloys, carbon fibers, foammetals, ceramics, ceramic composites, elastomer composites,elastomer-carbon fiber composites, chambered or fluid-filled materials,metal matrices, injectable gels, injectable composites with fluid andsold matrices, bone or bone-composite or allografts, crystal orhydroxyapatite materials, plastics (i.e., PEEK), polymers, bioabsorbablecomposites (i.e., TCP/PLLA), or combinations/composites of the abovematerials. The preferred materials for the system 106 have inherentelastic or shock absorbing properties.

In still a further embodiment of FIG. 20, the joint support andsubchondral support system 150 includes at least one non-telescopingprimary bearing strut element 152 of variable geometry and thicknesshaving a longitudinal body 154 and a vertically disposed inner edge 156and outer edge 158, suitable for insertion within the subchondral bone20. The basic geometric shape 162 of the primary bearing strut element152 is a circle as illustrated as a cut-away in FIG. 20A and as acomplete circle in FIG. 20B. At least one of the plurality of strutelements vertically disposed inner edge 156 and outer edge 158 istapered. The longitudinal body 154 has a porosity 155 to allowvascularity, bridging bone, and other biologic elements to pass through.The porosity 155 of the primary bearing strut element 152 ranges fromabout 50 microns to about 20 mm. As shown in FIGS. 21A-21C, the porosity155 may be comprised of micropores, scaffold-like pores, or a fibrousmatrix material, respectively.

The vertically disposed outer edge 158 of the at least onenon-telescoping primary bearing strut element 152 is contoured to fitthe subchondral bone 20 at the treatment site. As shown in FIGS.22A-22B, the outer edge 158 may be concave (FIG. 22A) such as the tibialplateau, convex (FIG. 22B) such as the femoral condyle, or complex (notshown) with both concave and convex curvatures, such as the femoraltrochlea. The vertically disposed inner edge 156 and outer edge 158include scalloping for penetration of the subchondral bone 20 duringinsertion of the system 150. The outer edge 158 has a plurality ofhollow grooves 151 (FIG. 20) formed vertically therethrough in which theplurality of hollow grooves are configured to receive a multi-prongedlongitudinal insertion holder 145 during insertion of the at least onenon-telescoping primary bearing strut element 152 within the subchondralbone 20 (FIGS. 25A-25B). In addition to the thickness taper that existsbetween the outer edge 158 and inner edge 156, a concentric taper 147 ofthe entire circle is present from the outer edge 158 to the inner edge156 (FIG. 22C). This allows for subjacent placement in a convex surface149 as well as further preventing subsidence. The degree of this taper147 may range from 3-10 degrees.

FIG. 23 illustrates the placement of the joint support and subchondralsupport system 150 in the subchondral bone 20 of the femoral condyle andtibial plateau in accordance with the present invention. The depth ofpenetration of the device 150 may vary depending on the exact pathologybeing treated as seen in FIGS. 24A-24C such that it may be below thelevel of the subchondral plateau (FIG. 24A), at the level of thesubchondral plateau (FIG. 24B), or above the subchondral plateau, flushwith the native cartilage (FIG. 24C).

FIG. 25A is an enlarged perspective view of a multi-pronged longitudinalinsertion holder 145 used in conjunction with the embodiment of FIG. 20during insertion of the joint support and subchondral support system ordevice 150 within the subchondral bone 20. The insertion holder 145 hasa proximal end 157 and distal end 159. A plurality of prongs or spikes161 at the distal end 159 are configured to fit in a plurality of hollowgrooves or vascular channels 151 at the outer edge 158 of thelongitudinal body 154 to effectively hold the device 150 during itsinsertion within the subchondral bone 20. It is contemplated by thepresent invention that one insertion holder 145 may be used per device150.

FIG. 25B illustrates the placement of the insertion holder prongs orspikes 161 within each of the plurality of hollow grooves or vascularchannels 151 of the embodiment of FIG. 20 during insertion of the device150 within the subchondral bone 20. During insertion of the device 150,the plurality of prongs or spikes 161 at the insertion holder distal end159 are pushed downward in the plurality of hollow grooves or vascularchannels 151 and are preferably extended past the inner edge 156. Theplurality of prongs or spikes 161 from the inserter holder 145 exit atthe scalloped inner edge 156 and outer edge 158 and are pushed deeperinto the subchondral bone 20. The device 150 and insertion holder 145are then tamped into the subchondral bone 20 and the insertion holder145 is then removed (not shown). The multi-pronged longitudinalinsertion holder 145 forms a plurality of vascular channels in thesubchondral bone 20 whereby blood/marrow may access the outer edge 158of the primary bearing strut element 152 via the plurality of hollowgrooves or vascular channels 151. Grooves 151 may also be in the form ofholes within the primary bearing strut element 152.

As shown in FIG. 26, it is further contemplated by the present inventionthat a bearing surface cover 163 may be attached to the periphery of theouter edge 158 that serves to contain marrow contents entering via thevascular channels or exogenous substances, injected through the cover(i.e., cultured chondrocytes). This cover 163 is made of either a thinnetted or woven material or biologic/synthetic membrane.

As shown in FIGS. 27A-27F, the geometric shape 162 of the primarybearing strut elements 152 can be a circle (FIG. 27A), multipleconcentric circle (FIG. 27B), joined circles (FIG. 27C), hexagon (FIG.27D), or octagon (FIG. 27E) or other non-linear, non-euclidean shapes,such as a hexagon with smoothed edges (FIG. 27F). The primary bearingstrut elements 152 configured to be joined together include at leastthree connecting struts 164 to form a multiple concentric circle (FIG.27B) in which each circle 166 of joined together primary bearing strutelements 152 is connected to an adjacent circle 166 by the connectingstruts 164.

It is further contemplated by the present invention that single ormultiple geometric shapes 162 may be configured to be joined to eachother in various patterns 168 (i.e., a honey-comb configuration) (FIG.28) such that the geometric shapes 162 may penetrate the subchondralbone 20 and enable use with different size cartilage lesions at thetreatment site. The geometric shapes 162 may mirror the entire jointcompartment if the entire compartment is involved, i.e., trochlea,lateral patellar facet, medial tibial platea, etc. The geometric shapes162 may be inserted within the subchondral bone 20 either piecemeal ormonobloc via antegrade insertion (i.e., from the joint surface).

The dimensions of the joint support and subchondral support system 150generally depend on the size of the lesion being treated. In particular,the primary bearing strut elements 152 configured to be joined togetherin a geometric shape 162 each have a diameter of from about 1 mm toabout 5 cm and a height/depth of from about 1 mm to about 3 cm.

FIG. 29A illustrates a cut-away view of the primary bearing strutelement 152 with a primary bearing flare 170. In a further embodimentshown in FIG. 29B, the primary bearing strut element 152 includes asecondary bearing flare 172 extending below the strut element 152. Thesecondary bearing flare 172 can be in the form of either a verticaldouble tapered wing strut 174 or obliquely extending arm 176. Thesesecondary flares 172 serve to further resist subsidence.

At least one active or passive dampening element 178 (FIG. 29B) isattached to the primary bearing strut element 152. The dampening elementmay be inherent to the material properties of the device 150, i.e.,silicone-inject porous metal matrix. A dampening element, such as apiezoelectric device, converts active mechanical energy to heat orelectric, thereby dissipating and dampening the shock.

The joint support and subchondral support system 150 of the presentinvention may be fabricated from virtually any biocompatible material,including, but not limited to, metals, metal alloys, carbon fibers, foammetals, ceramics, ceramic composites, elastomer composites,elastomer-carbon fiber composites, chambered or fluid-filled materials,metal matrices, injectable gels, injectable composites with fluid andsold matrices, bone or bone-composite or allografts, crystal orhydroxyapatite materials, plastics (i.e., PEEK), polymers, bioabsorbablecomposites (i.e., TCP/PLLA), or combinations/composites of the abovematerials. The preferred materials for the system 150 have inherentelastic or shock absorbing properties.

The methods of use of the joint support and subchondral support system150 for providing structural and dampening support to damagedsubchondral bone adjacent to a body joint are in accordance with theinsertion techniques previously discussed above and as shown in theaccompanying drawings, namely, FIGS. 20-29, for this embodiment.

Referring now to FIG. 30 in a further embodiment of the presentinvention, the joint support and subchondral support system 180 includesa primary bearing strut element 182 of variable geometry and thicknesshaving a longitudinal body 184 and an inner edge 186 and an outer edge188. The longitudinal body 184 has a porosity to allow vascularity,bridging bone, and other biological elements to pass through. The outeredge 188 has at least two grooves 189 formed therein an inner surface190 of the longitudinal body 184 and contoured to fit the subchondralbone 20 at the treatment site. The system 180 further includes acontoured, porous plate 192 having a variable shaped inner surface 194,outer surface 196, and peripheral surface 198 of variable thicknessextending between the inner surface 194 and outer surface 196, suitablefor insertion within the subchondral bone 20. The inner surface 194,outer surface 196, and peripheral surface 198 each have a respectiveconcave portion 194A, 196A, 198A and a respective convex portion 194B,196B, 198B. The inner edge 186 of the primary bearing strut element 182is in direct communication with the contoured, porous plate 192 withinthe subchondral bone being treated. The contoured, porous plate 192 ofthe joint support and subchondral support system 180 may include aplurality of surface dimples 202 and undersurface pimples 204 aspreviously described above.

FIG. 31 illustrates the placement of the joint support and subchondralsupport system 180 in the subchondral bone 20 of the femoral condyle andtibial plateau in accordance with the present invention.

It is contemplated by the present invention that the joint support andsubchondral support system 180 may be inserted within the subchondralbone 20 according to the insertion techniques previously discussedabove.

At least one active or passive dampening element 206 is attached to thejoint support and subchondral support system 180. A dampening element,such as a piezoelectric device, converts active mechanical energy toheat or electric, thereby dissipating and dampening the shock.

As with the previous embodiments, the joint support and subchondralsupport system 180 of the present invention may be fabricated fromvirtually any biocompatible material, including, but not limited to,metals, metal alloys, carbon fibers, foam metals, ceramics, ceramiccomposites, elastomer composites, elastomer-carbon fiber composites,chambered or fluid-filled materials, metal matrices, injectable gels,injectable composites with fluid and sold matrices, bone orbone-composite or allografts, crystal or hydroxyapatite materials,plastics (i.e., PEEK), polymers, bioabsorbable composites (i.e.,TCP/PLLA), or combinations/composites of the above materials. Thepreferred materials for the system 180 have inherent elastic or shockabsorbing properties.

FIG. 32 illustrates the placement of the joint support and subchondralsupport system 10, 50, 106, 150, 180 of each of the aforementionedembodiments discussed above in subchondral bone 20 of a knee joint 22.The present invention contemplates that each of the embodiments of thejoint support and subchondral support system 10, 50, 106, 150, 180 maybe used in combination with one another to provide enhanced structuraland dampening support to damaged subchondral bone 20 adjacent to a bodyjoint.

The above-described elements for each of the embodiments may be variedin design, function, operation, configuration, materials, anddimensions, and are not limited to the descriptions provided herein.

Having now described the invention in accordance with the requirementsof the patent statutes, those skilled in the art will understand how tomake changes and modifications in the present invention to meet theirspecific requirements or conditions. Such changes and modifications maybe made without departing from the scope and spirit of the invention asset forth in the following claims.

1. A joint support and subchondral support system for providing structural and dampening support to damaged subchondral bone adjacent to a body joint, comprising: at least one non-telescoping primary bearing strut element of variable geometry and thickness having a longitudinal body and a vertically disposed inner edge and outer edge, suitable for insertion within the subchondral bone; the longitudinal body having a porosity to allow vascularity, bridging bone, and other biological elements to pass through; the vertically disposed inner edge and outer edge having pronged scalloping at a bottom end to penetrate the subchondral bone during insertion and to maintain the at least one non-telescoping primary bearing strut element in place within the subchondral bone; and the vertically disposed outer edge having a plurality of hollow grooves formed vertically therethrough, wherein the plurality of hollow grooves are configured to receive a multi-pronged longitudinal insertion holder during insertion of the at least one non-telescoping primary bearing strut element within the subchondral bone, and the vertically disposed outer edge is contoured to fit the subchondral bone at a treatment site.
 2. The joint support and subchondral support system of claim 1, wherein the multi-pronged longitudinal insertion holder forms a plurality of vascular channels in the subchondral bone during insertion of the at least one non-telescoping primary bearing strut element within the subchondral bone whereby blood or marrow may access the vertically disposed outer edge through the plurality of hollow grooves or vascular channels.
 3. The joint support and subchondral support system of claim 1, wherein single or multiple geometric shapes of the at least one non-telescoping primary bearing strut element may be configured to be joined to each other in various patterns such that the single or multiple geometric shapes penetrate the subchondral bone at the treatment site.
 4. The joint support and subchondral support system of claim 3, wherein the single or multiple geometric shapes configured to be joined together include at least three connecting struts to form a multiple concentric circle in which each circle of the at least one non-telescoping primary bearing strut element is connected to an adjacent circle by the connecting struts.
 5. The joint support and subchondral support system of claim 1, wherein the at least one non-telescoping primary bearing strut element has a diameter of from about 1 mm to about 5 cm and a height/depth of from about 1 mm to about 3 cm.
 6. The joint support and subchondral support system of claim 1, wherein the at least one non-telescoping primary bearing strut element includes a primary bearing flare for resisting subsidence within the subchondral bone at the treatment site.
 7. The joint support and subchondral support system of claim 1, wherein the at least one non-telescoping primary bearing strut element includes a secondary flare extending below the strut element for further resisting subsidence within the subchondral bone at the treatment site.
 8. The joint support and subchondral support system of claim 7, wherein the secondary flare is at least one of a vertical, double-tapered wing strut, and obliquely extending arm.
 9. The joint support and subchondral support system of claim 1, wherein the porosity of the longitudinal body may be comprised of micropores, scaffold-like pores, or a fibrous matrix material.
 10. The joint support and subchondral support system of claim 1, wherein the at least one non-telescoping primary bearing strut element includes a concentric taper from the vertically disposed outer edge to the inner edge.
 11. The joint support and subchondral support system of claim 1, wherein the at least one non-telescoping primary bearing strut element may have a geometry in the form of a multiple concentric circle, joined circles, hexagon, octagon, or other non-euclidean shapes.
 12. The joint support and subchondral support system of claim 1, wherein a biocompatible bearing surface cover may be attached to a periphery of the vertically disposed outer edge to contain marrow contents entering through vascular channels or exogenous substances injected through the cover.
 13. The joint support and subchondral support system of claim 1, wherein at least one active or passive dampening element is attached to the at least one non-telescoping primary bearing strut element for dissipating and dampening shock within the subchondral bone.
 14. A method of providing structural and dampening support to damaged subchondral bone adjacent to a body joint, comprising: providing at least one non-telescoping primary bearing strut element of variable geometry and thickness having a longitudinal body and a vertically disposed inner edge and outer edge, suitable for insertion within the subchondral bone; contouring the vertically disposed outer edge to fit the subchondral bone at the treatment site; providing a multi-pronged longitudinal insertion holder; configuring the vertically disposed outer edge to have a plurality of hollow grooves formed vertically therethrough for receiving the multi-pronged longitudinal insertion holder; penetrating the subchondral bone during insertion of the at least one non-telescoping primary bearing strut element within the subchondral bone at the treatment site; maintaining the at least one non-telescoping primary bearing strut element in place within the subchondral bone; and allowing vascularity, bridging bone, and other biological elements to pass through a porosity of the longitudinal body when positioned at the treatment site.
 15. The method of claim 14, wherein configuring the vertically disposed outer edge to have a plurality of hollow grooves formed vertically therethrough includes slidably disposing the multi-pronged longitudinal insertion holder downward through the plurality of hollow grooves at the vertically disposed outer edge during insertion of the at least one non-telescoping primary bearing strut element within the subchondral bone at the treatment site.
 16. The method of claim 14, wherein penetrating the subchondral bone includes forming a plurality of vascular channels in the subchondral bone during insertion of the at least one non-telescoping primary bearing strut element within the subchondral bone whereby blood or marrow may access the vertically disposed outer edge through the plurality of hollow grooves or vascular channels.
 17. The method of claim 14, wherein penetrating the subchondral bone includes configuring the vertically disposed inner edge and outer edge to have pronged scalloping at a bottom end suitable for penetrating the subchondral bone during insertion of the at least one non-telescoping primary bearing strut element within the subchondral bone at the treatment site.
 18. The method of claim 14, wherein penetrating the subchondral bone includes tamping the at least one non-telescoping primary bearing strut element and multi-pronged longitudinal insertion holder into the subchondral bone and removing the multi-pronged longitudinal insertion holder from the treatment site.
 19. The method of claim 14, wherein maintaining the at least one non-telescoping primary bearing strut element in place within the subchondral bone includes configuring the vertically disposed inner edge and outer edge to have pronged scalloping at a bottom end thereof.
 20. The method of claim 14, wherein maintaining the at least one non-telescoping primary bearing strut element in place within the subchondral bone includes configuring the at least one non-telescoping primary bearing strut element to have a primary bearing flare for resisting subsidence within the subchondral bone at the treatment site.
 21. The method of claim 14, wherein maintaining the at least one non-telescoping primary bearing strut element in place within the subchondral bone includes configuring the at least one non-telescoping primary bearing strut element to have a secondary flare extending below the strut element for further resisting subsidence within the subchondral bone at the treatment site.
 22. The method of claim 21, wherein configuring the at least one non-telescoping primary bearing strut element to have a secondary flare extending below the strut element includes forming the secondary flare as a vertical, double-tapered wing strut or an obliquely extending arm.
 23. The method of claim 14, wherein allowing vascularity, bridging bone, and other biological elements to pass through a porosity of the longitudinal body includes configuring the porosity of the longitudinal body to be comprised of micropores, scaffold-like pores, or a fibrous matrix material. 